Healthcare Provider Details

I. General information

NPI: 1659080653
Provider Name (Legal Business Name): JOLENE UNDERWOOD MA, LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

4380B MONTGOMERY RD # 1032
ELLICOTT CITY MD
21043-6006
US

V. Phone/Fax

Practice location:
  • Phone: 301-244-8645
  • Fax:
Mailing address:
  • Phone: 301-244-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number87828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: